Osteoarthritis and Principles of Management

Question 1

How is OA defined?

Answer 1

Tear, flare and repair
Trauma and mechanical imbalance
Inflammation and pain
Repair processes around joint

Question 2

Biomechanical risk factors

Answer 2

Abnormal anatomy (DDH)     
Intra-articular fracture
Ligament rupture
Meniscal injury
Occupation – farmers, football players
Persistent heavy physical activity
Elite running
Obesity

Question 3

DDH

Answer 3

Developmental dysplasia of the hip

Question 4

Inflammatory causes

Answer 4

Synovial hypertrophy
Subchondral changes
Joint effusion

Question 5

Pathogenesis of OA

Answer 5

Muscle weakness, ligament injury, abnormal anatomy => instability/malalignment
Instability/malalignment / Obesity => increased load => joint microtrauma => osteoarthritic joint

Question 6

OA diagnosis

Answer 6

45 yrs +
Activity-related joint pain plus:
has either no morning joint-related stiffness or morning stiffness that lasts no longer than 30 minutes
X ray to confirm

Question 7

Differential diagnosis

Answer 7

Gout
Other inflammatory arthritides
Septic arthritis
Malignancy

Question 8

Non-pharmacological treatments

Answer 8

Thermotherapy
Electrotherapy
Aids and devices
Manual therapy

NICE do not recommend: acupuncture, nutraceuticals (glucosamine, chondroitin)

Question 9

Pharmacological treatments

Answer 9

Oral analgesia:
   -Paracetamol
   -NSAIDs
Topical treatments:
   -NSAIDs
   -Capsaicin (knee, hand)               
Intra-articular injections:
   -Steroid
   -(hyaluronic acid)

Question 10

Management

Answer 10

Non-pharmacological treatments
Pharmacological treatments
Surgery